Vasopressors in Hypotension

Author: Todd A. Seigel, MD
Updated: 8/20/2013

Choosing the Right Vasopressor Agent in Hypotension

Table of Vasopressor Effects, Side Effects, and Prototypical Clinical Scenario

Side effects of vasoactive medications are related both to the direct mechanism of action of the agent, as well as the compensatory mechanisms precipitated by them. Concerning side effects of inotropes include dysrhythmias and increased myocardial oxygen demand, whereas vasopressors can cause undesired limitations in blood flow to the gut and kidneys.

Agent Primary Receptor Primary Impact Potential Side Effect Prototypical Clinical Scenario
Phenylephrine α1 Increased SVR Reflexive decreased HR Neurogenic shock
Vasopressin V Increased SVR Decreased splanchnic flow Adjunct for septic shock
Dobutamine β1, β2 Increased inotropy Transient decreases in SVR (β2 agonsim) Cardiogenic shock from late-stage heart failure
Dopamine (low-dose) D, β1 Increased inotropy and heart rate Tachydysrhythmias Cardiogenic shock, particularly if bradycardic
Epinephrine α1, α2, β1, β2 Increased SVR and inotropy Tachydysrhythmias and decreased splanchnic flow Anaphylaxis
Norepinephrine α1, α2, β1>> β2 Increased SVR and inotropy Decreased splanchnic and renal flow Septic shock
Dopamine (high-dose) D, α1, β1>> β2 Increased SVR and inotropy Tachydysrhythmias and decreased splanchnic/renal flow Bradycardic cardiovascular collapse

References

  • Vasu TS, Cavallazzi R, Hirani A, Kaplan G, Leiby B, Marik PE. Norepinephrine or dopamine for septic shock: systematic review of randomized clinical trials. J Intensive Care Med 2012;27:172-8. [PubMed]
  • Annane D, Vignon P, Renault A, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet 2007;370:676-84. [PubMed]
  • Myburgh JA, Higgins A, Jovanovska A, Lipman J, Ramakrishnan N, Santamaria J. A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med 2008;34:2226-34. [PubMed]
  • Ellender TJ, Skinner JC. The use of vasopressors and inotropes in the emergency medical treatment of shock. Emerg Med Clin North Am 2008;26:759-86, ix. [PubMed]
  • De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med 2012;40:725-30. [PubMed]

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